Transcript problem statements

Gönül KURT (RN, PhD)
PROBLEM STATEMENTS
Intensive Care Units (ICUs) provide increasingly sophisticated treatments to
those who are critically ill.
The primary goals of intensive care
medicine are to help patients
survive acute threats to their lives
while preserving and restoring the
quality of those lives.
These goals are frequently achieved, with approximately 75% to 90% of
patients admitted to an intensive care unit surviving to discharge .
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PROBLEM STATEMENTS
Unfortunately, this goal is not always obtained and despite great
improvements in the care of critical patients, death is frequent in the
Intensive Care Units.
The mortality rate reported in international studies ranges between 7% and
20%.
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PROBLEM STATEMENTS
• A high percentage of patients die in the
Intensive Care Units, often after a prolonged
period of illness and being unable to make
decisions for themselves.
• Timely communication about life expectancy and
end-of-life care is crucial for ensuring good patient
quality-of-life at the end of life and a good quality of
death in Intensive Care Units.
• For these reasons, ethical problems in ICUs are
common, especially when caring for patients at the
end of life.
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PROBLEM STATEMENTS
Thus, medical professionals who work in intensive care units must have
the ability to analyze, evaluate and make decisions in ethical issues that
are relevant to their duties, making use of ethical theories and principles.
It is necessary that they should have an ability to understand ethical
concepts such as rights, justice, freedom and autonomy, and to analyze
and understand ethical reasoning based on ethical theory.
Analyze
Making
decision
Evaluate
Ethical
principles
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PROBLEM STATEMENTS
In particular, professional nurses need to make special efforts to
enable them to cope effectively with practical situations presenting
ethical dilemmas.
Because given their proximity to patients and families, nurses working in
ICU have an important role in end of life decision-making. These
decisions are ethical in nature as they relate to quality and sanctity of
life and to balancing ethical principles such as respect for autonomy,
do well, minimize harm and treat people justly.
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PROBLEM STATEMENTS
• Nurses have a pivotal role in a person’ s
end of life and nurses’ knowledge, skills
and attitude towards death and dying and
end-of-life care affect the care that they
provide for these patients.
• Therefore, it is imperative that nurses
receive education about end-of-life care in
their prelicensure curriculum so that they
are prepared to care for dying patients.
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PURPOSE
The aim of this study to
determine the ethical
decision-making practice of
nursing students about endof-life care in Intensive Care
Units.
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MATERIAL & METHODS
Study Location:
Intensive Care Units of an University Hospital
Study Type:
Descriptive study
Study Time:
January-June 2015
Study Sample
The study sample consisted of a total of 87 student nurses who work with
dying patients in ICU.
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MATERIAL & METHODS
Measures:
A “Data Collection Form” and “Nursing Dilemma Test (NDT) to
measure nursing students' responses to nursing dilemmas and to
determine the ethical decision-making level of the students was used
for data collection.
The Data Collection Form was developed by the present investigator
after evaluation of the relevant literature. The questionnaire consisted of
10 questions.
NDT was developed by Crisham in 1981 to measure nurses' responses to
nursing dilemmas and the importance given to moral issues and practical
considerations.
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MATERIAL & METHODS
Measures:
Crisham (1981) developed the NDT based on experienses of the 130
staff nurses. The instrument contains six vignettes addressing the ethical
issues of “deciding right to know and determining right to decide,
defining and promoting quality of life, maintaining professional and
institutional standards, and distributing nursing resources”.
The six vignettes deal with the following problems: Newborn with
anomalies, Forcing Medication, Adult’s Request to Die, New Nurse
Orientation, Medication Error, Uninformed Terminally ill Adult.
The NDT examines willingness to act, familiarity with the dilemma
presented, importance of practical considerations, and level of moral
reasoning, which is made up of nursing –principled items for each of
the six nursing dilemmas.
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MATERIAL & METHODS
Data Collection:
The hospital Institutional Review Board approved this study.
Participating nursing students provided verbal consent after the aim and
method of the study were explained.
Students independently completed the forms in their classrooms under
the supervision of researchers.
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MATERIAL & METHODS
Data Analyses:
The SPSS 15.0 software package was used for statistical analysis.
Categorical variables were expressed as counts and percentages.
Continuous variables were summarized with means and standard
deviation.
Conformity the normal distribution of data was assessed by One-Sample
Kolmogorov-Smirnov test.
According to the conformity the normal distribution of data, the
independent sample t test was used for statistical comparison between
two groups, as appropriate.
A p value less than 0.05 will accepted as statistically significant.
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X
RESULTS
Face with the dying patient and felt emotions of students
n=87
Encounter with dying patient
n
%
No
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5.7
Yes
82
94.3
Sadness
75
86.2
Feelings of helplessness
47
54.0
Fear
41
47.1
Inadequacy
47
54.0
Feel like crying
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27.6
Desperation
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14.9
Grief
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10.3
Felt emotions while caring the dying patient
Age of students
X ± SD
21.98 ± 0.28
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RESULTS
Most of the students (58.6%) think that the aim
of end-of-life care is relieved pain of dying
patients and 40.2% of students think that it
improved quality of life.
The students (64.4%) think that it should be
given care the dying patients at home but 29.8%
of students think that it should be given care the
dying patients at hospital by health care
providers.
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Mean scores of students in Nursing Dilemma Test (n=87)
Sub-scale of Nursing Dilemma Test
X±SD
Nursing Principled Thinking
48.57±5.66
Practical Consideration
16.78±3.03
Familiarity
16.79±2.25
The Nursing Principled Thinking level was above average, while Practical Considerations
level was nearly at the level of average. These findings showed that students notice to decide
taking into account the ethical principles if there is any ethical issues and students who decide
ethical issues take into account environmental factors, relatively.
It was found that nurses were familiar to the similar nursing dilemmas.
A significant relationship between Practical Considerations level and have experienced the
death of a person from the family was found (t=2.899; p<0.05).
While deciding about ethical issues, the students who have experienced the death of a person
from the family had significantly lower take into account environmental factors than the others.16
CONCLUSIONS
We found that nursing students notice to decide taking into account the
ethical principles and environmental factors while decide any ethical
issues.
In the health care environment nurses encounter ethical issues daily.
These issues are seldom the major ethical dilemmas, but minor issues
that nurses face in their every-day contact with patients. To solve these
issues, nurses need skills in ethical decision-making.
Therefore nurses should be capable of making autonomous ethical
decisions. For this reason, the content of nursing education for students
should include the procedures necessary for applying universal theories
to real situations, by means of case studies and practical training in
the analysis of ethical dilemmas.
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CONCLUSIONS
Nurses have a pivotal role in a person’ s end of life and
nurses’ knowledge, skills and attitude towards death and
dying and end-of-life care affect the care that they provide
for these patients.
Therefore, it is imperative that nurses receive education
about end-of-life care in their prelicensure curriculum so
that they are prepared to care for dying patients.
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THANK YOU FOR YOUR
ATTENTION...
REFERENCES
1.
Han S.S., Ahn S.H. An Analysis And Evaluation of Student Nurses’ Participation In
Ethical Decision Making, Nursing Ethics , 2000; 7 (2):113-123.
2.
Crisham P. Measuring moral judgement in nursing dilemmas. Nursing Research ,1981; 30
(2):104-110.
3.
Truog R.D. Et. all. Recommendations for end-of-life care in the intensive care unit: A
consensus statement by the American College of Critical Care Medicine. Crit Care Med.,
2008; 36 (3): 953-963.
4.
Campbell ML, Guzman JA. A proactive approach to improve end-of-life care in a medical
intensive care unit for patients with terminal dementia. Crit Care Med., 2004; 32: 1839–
1843.
5.
International Nurses’ End-of-Life Decision-Making in Intensive Care Research Group.
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intensive care unit. 1-19.
6.
Papadimos T.J. et al.. An overview of end-of-life issues in the
intensive care unit. International Journal of Critical Illness and Injury Science, 2011;1(2):
138-146.
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